Studies Explore Patient, Physician Perspectives on


Treating Pain Effectively


By Houkje Ross


Closing the Gap, Cancer • August 2000


Patients have the right to control pain associated with cancer and duce the impact of pain on daily life, and improve the quality of life of 

need to learn how to talk with their doctors about it, according patients. 

to the Pain Research Group (PRG) at the University of Texas 

M.D. Anderson Cancer Center. Educating minority patients about Physicians Have Fears Too 

their pain and how to manage it could help reduce the severity of pain 

many minority cancer patients face. Patients are not the only ones reluctant to use prescription analThe PRG is conducting clinical studies called Pain Relief Educa- gesics to decrease cancer pain. Physicians and doctors often have a 

tion for Minority Outpatients (PREMO). These trials, which are hard time with it as well. Analgesics, which are medications such as 

targeting nearly 900 Hispanic and African Ameri- codeine for moderate pain and morphine, Demerol, 

can patients, are using easy-to-understand print and or dilaudid for heavier pain, are the types of drugs 

video materials to educate African Americans and “Fears of becoming most often prescribed to cancer patients. Recent 

Hispanics who have cancers of the breast and pros- studies by PRG show that minorities with cancer addicted to pain tate, solid tumors, or hematological malignancies— often suffer more from pain due to under-medicalymphoma or leukemia. PREMO patients learn how medication may also tion. Researchers found that nearly 62 percent of 

to describe pain and talk with their doctors about it. patients at institutions serving predominately AfriPatricia Washington, DSN, RN, coordinator play a large part can American patients were not prescribed adequate 

for the PREMO trials, said persistent pain associ- analgesics. At institutions serving primarily Hispan­ in the reluctance to ated with cancer becomes more pronounced when ics, 82 percent met the criteria for under-medicathe cancer has metastasized, or spread to other parts use medication.” tion. According to a University of Wisconsin Mediof the body. “This is when cancer becomes very 

painful,” Washington said. Cancer pain is continuous, and without medication, the pain usually gets worse rather than 

better. Research suggests that many cancer patients, minority and 

white, are reluctant to report their pain and that is when under medication may result. 

Patients Often Face Fear 

Washington said that patients sometimes feel “overwhelmed” by 

what a doctor is telling them and are afraid to ask questions or admit 

they are in pain. 

“A patient may not understand the technical language a doctor is 

using and nod his or her head yes, when he or she really doesn’t know 

what the doctor is saying in the first place,” she said. 

The Seattle, WA based International Association for the Study of 

Pain (IASP) said that the fear of becoming addicted to pain medication could play a large part in the reluctance to use medication. IASP, 

which is an international, multidisciplinary, nonprofit professional 

association dedicated to furthering research on pain and improving 

the care of patients with pain, also said that many minority patients 

who are older, less educated, or lower income, are more likely to have 

these fears. 

“Many patients don’t like to take their pain medication because 

they fear being out of control,” Washington said. It is common for 

patients to have to take a pill every four hours to manage cancer pain, 

but many patients and family members don’t understand this and 

think it is too much, she added. The PREMO studies 

will assess whether patient education on pain management will improve pain control, according to the Pain 

Research Group. The studies are intended to help recal School survey, physicians tend to overestimate 

the side effects from medications used to treat cancer pain. 

“Doctors may not take the time to assess pain accurately in their 

patients or they may not know the correct standards to follow in 

prescribing pain medications,” Washington said. “Sometimes they are 

even afraid of losing their license for prescribing too much pain medication,” she added. 

A recent PRG surveys asked 1,177 oncology physicians to rank 

12 barriers to adequate cancer pain management. Lack of proper assessment and a need for better communication about pain between 

patient and health care providers were ranked as the greatest barriers. 

Washington said that time is often a barrier, too. “Community 

hospitals see large numbers of patients, so time is limited for doctors. 

They are just so busy,” she said. 

According to IASP, proper assessment of pain comes when health 

care workers take into account a patient’s mood, attitude, coping efforts, and resources, the responses of family members, and the impact 

of pain on their lives. A patient’s experience could be difficult to 

communicate because the patient and provider may have different 

languages, experiences, expectations, and frames of reference. Other 

factors that sometimes contribute to pain intensity are the psychological influences. Fear, anxiety, depression, or social isolation can magnify 

cancer pain, according to IASP. 

Culture and Language are Important 

In a 1998 study conducted by the City of Hope National Medical Center in Duarte, CA, researchers stressed consideration for a patient’s overall beliefs and values. Some Hiscontinued>>>> 

Office of Minority Health Resource Center 1 U.S. Department of Health and Human Services 
Studies Explore Patient, Physician Perspectives on 

Treating Pain Effectively 

By Houkje Ross 

Closing the Gap, Cancer • August 2000 

panic patients may use folk healthcare practices, the study said. Researchers also recommend that physicians incorporate the patient’s 

practices and beliefs into the plan of care when possible and involve 

family members and friends. Identifying one key family contact can 

also help. Researchers also emphasized the use of bilingual instructions for medications. Ensure that instructions for medications are 

available in Spanish and understood by the patient and the caregiver, 

the report said. The study went on to say that the lack of understanding instructions for taking pain medication was the most common 

reason cited for noncompliance with pharmacological treatment. 

To help physicians assess pain in clinical and research settings, 

PRG developed a survey called the Brief Pain Inventory. The Brief 

Pain Inventory is designed to aid physicians in assessing the severity of 

pain, its impact on daily functions, location, and types of pain medications that a patient may already be taking. The Brief Pain Inventory 

is available in several languages including Chinese, Japanese, Spanish, 

and Vietnamese. For more information on PREMO Studies, or the Brief 

Pain Inventory, contact the Pain Research Group at the University of 

Texas M.D. Anderson Cancer Center, (713) 745-3470.

Office of Minority Health Resource Center 2 U.S. Department of Health and Human Services